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General NPI Number Information
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NPI Number | 1881291334
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Entity Type | Individual
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Provider Name | TRACIE RAE BAXTER-WINTROW LSW
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Gender | Female
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 1303 E MAIN ST
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City | COLUMBUS
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State | OH
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Zip | 43205-2047
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Country | US
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Telephone | 614-252-6927
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Fax | 614-252-4367
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Provider Business Mailing Address
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Address Line | 1801 WATERMARK DR STE 200
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City | COLUMBUS
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State | OH
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Zip | 43215-7088
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Country | US
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Telephone | 614-487-8758
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Fax | 614-487-8759
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2004662
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License Number State | OH
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